Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Medicine leads the professions in suicide. What can we do about it?

Richard Gunderman, MD, PhD and Peter Gunderman, MD
Physician
May 30, 2018
Share
Tweet
Share

Earlier this month, one of us visited a prominent U.S. medical school to give a lecture on the topic of burnout and how physicians can find more fulfillment in the practice of medicine. Sadly, that very day, a fourth-year medical student there took her own life.

The problem was not personal failure. She had recently matched into a competitive residency program at the one of the nation’s most prestigious hospitals. Yet apparently, she still found the prospect of the life ahead more than she could bear.

This is hardly an isolated incident. A study reported earlier this month at the annual meeting of the American Psychiatric Association revealed that among U.S. professionals, physicians have the highest suicide rate. According to the researchers, the suicide rate in medicine is more than twice that of the general population, resulting in at least one physician suicide per day in the U.S. In fact, the actual number is probably higher, as the stigma of suicide results in underreporting.

The news gets even worse. There is good reason to think that when it comes to distress among physicians, suicide is only a particularly noticeable indicator of a much larger problem. For every physician who attempts suicide, many others are struggling with burnout and depression. One recent survey found that 42 percent of U.S. physicians are burned out, with rates of 38 percent among men and 48 percent among women. Such distress manifests in other ways, such as alcoholism, substance abuse and poor patient care.

High stress, but high rewards

From one point of view, these findings are not surprising. Medicine has long been recognized as a stressful profession, characterized by competitiveness, long hours and lack of sleep. Many physicians work each day with the knowledge that a mistake could lead to the death of a patient, as well as the frustration that, despite their best efforts, some patients will elect not to comply with medical recommendations and others, despite doing so, will still get sicker and die.

And yet physicians seem to have much to be grateful for. Compared to Americans in other lines of work, they are highly educated and well compensated. They enjoy a relatively high level of respect and trust. And their work provides them with regular opportunities to make a difference in the lives of patients, families and communities. They are privileged to care for human beings in some of their most memorable moments, such as in birth and death, and they may occasionally save someone’s life.

Test pilots

Why then might suicide rates among physicians be so high?

While there are undoubtedly many factors, ranging from problems in the health care system to individual circumstances, the recent death of novelist Tom Wolfe at age 88 has inspired us to look at the problem from a different perspective. The author of numerous works of both fiction and nonfiction, Wolfe’s best-selling book was 1979’s “The Right Stuff,” which chronicled the early days of the U.S. space program.

“The Right Stuff” is populated by two very different sets of heroes. First there are the test pilots, represented by Chuck Yeager, a former flying ace who in 1947 became the first person to break the sound barrier during level flight in his X-1 rocket-powered jet.

By Wolfe’s account, the test pilots were men of daring who regularly pushed the limits of human flight, placing themselves in hazardous situations where failure to respond to problems in a split-second could result in mission failure and even death. In his introduction to the 1983 edition, Wolfe reports a pilot mortality rate of 23 percent. During the 1950s, this translated into about one death per week.

Yet morale and camaraderie among the test pilots were high. They believed that they were promoting patriotism, expanding the human capacity for exploration, and bravely breaking what were thought to be unbreakable human limits. Said Yeager, “What good does it do to be afraid? It doesn’t help anything. You better try and figure out what is happening and correct it.”

Astronauts

Through no choice of their own, the later Mercury astronauts were a very different breed, Wolfe found. Though many had experience as both combat and test pilots, their role in space exploration would resemble that of passengers more than pilots. For example, they were selected based less on their bravery, judgment or skill than on their ability to withstand a battery of grueling and sometimes humiliating tests that included nausea-inducing centrifuge rides and castor-oil enemas.

In other words, the astronauts functioned less as test pilots than test subjects. The work of piloting the flights would largely be done by computers and ground control, and the astronauts’ role was largely to endure them. When it came to the design of the Mercury capsule, they had to fight for a window through which they could see where they were going, a hatch that they could open from the inside, and even minimal manual control over the rocket.

ADVERTISEMENT

The astronauts and their families were revered by the American public, who marveled at the courage it took to ride a rocket into the unknown, but it was not enough for the men themselves. They longed to do something. In “The Right Stuff,” Yeager captures much of their frustration when he turns away from the project saying, “Anyone who goes up in that damn thing is going to be spam in a can.”

Physicians: test pilots or astronauts?

The contrast between pilots and astronauts captures nicely some of the disappointments and frustrations facing U.S. physicians. Having entered medicine believing that their own knowledge, compassion and experience would help make the difference between health and illness and even life and death for their patients, they have found themselves inhabiting a very different reality, one that often leaves them feeling more like passengers than pilots.

Consider how physician performance is assessed. In the past, physicians sank or swam based on their professional reputations. Today, by contrast, the work of physicians tends to be evaluated by the quality of their documentation, their compliance with policies and procedures, the degree to which their clinical decision-making conforms to prescribed guidelines, and satisfaction scores. Over the past few decades, the physician has become less of a decision-maker and more of a decision implementer.

Why is this discouraging? Just as only the test pilot knows what is happening in the cockpit from second to second, a physician is often the only health professional who gets to know patients as people, including each one’s particular needs and concerns. Being assessed by metrics promulgated by economists, policymakers and health care executives who have never met the patient gives the practice of medicine a hollow feel.

Most physicians don’t want to be astronauts, hurtling uncontrollably into a health care future they cannot see. Instead they want to be pilots – professionals who exemplify why having eyes and ears on the patient is far more important than mastering a computer system or billing code. They don’t want to be astronauts, stuck in a can that dictates their every move and provides no opportunity to make the kind of difference for patients that generates personal challenge and growth.

The situation is summed up nicely by a crayon drawing by a six-year-old patient we saw recently. Entitled, “My Visit to the Doctor,” it depicts a young patient seated on an examination table, facing the doctor. The doctor, however, is across the room at a desk, facing away from the patient, bent down over a computer into which he is entering data. The implicit message of this simple image? The computer is more important to the doctor than the patient.

The ConversationIf we want to stem the tide of burnout, depression and suicide in medicine, we need to enable doctors to be good doctors – not mere “health care providers” – and to practice medicine in a way they can be proud of. We must allow and even encourage them not merely to manage health information but to care for human beings. Like the early astronauts, physicians, especially the best among them, cannot thrive if they remain relegated to the role of Ham the Astrochimp, America’s first chimpanzee astronaut.

Richard Gunderman is Chancellor’s Professor, Schools of Medicine, Liberal Arts, and Philanthropy, Indiana University, Indianapolis, IN.  Peter Gunderman is a transitional year resident. This article was originally published on The Conversation. Read the original article.

Image credit: Shutterstock.com

Prev

How going part-time rescued this burned out physician

May 30, 2018 Kevin 2
…
Next

Making progress in curbing opioid use in hospitals

May 30, 2018 Kevin 3
…

Tagged as: Psychiatry, Public Health & Policy

Post navigation

< Previous Post
How going part-time rescued this burned out physician
Next Post >
Making progress in curbing opioid use in hospitals

ADVERTISEMENT

Related Posts

  • How social media leads to a loss of creativity

    Edwin Leap, MD
  • How social media can advance humanism in medicine

    Pooja Lakshmin, MD
  • Start with the students: Addressing the future of physician suicide

    Anonymous
  • Why academic medicine needs to value physician contributions to online platforms

    Ariela L. Marshall, MD
  • Physician suicide: We need safe spaces to talk about it

    Ton La, Jr., MD, JD
  • The difference between learning medicine and doing medicine

    Steven Zhang, MD

More in Physician

  • How tragedy shaped a medical career

    Ronald L. Lindsay, MD
  • A doctor’s guide to preparing for your death

    Joseph Pepe, MD
  • How policy and stigma block addiction treatment

    Mariana Ndrio, MD
  • Why don’t women in medicine support each other?

    Jessie Mahoney, MD
  • IMGs are the future of U.S. primary care

    Adam Brandon Bondoc, MD
  • The high cost of gender inequity in medicine

    Kolleen Dougherty, MD
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • Healing from medical training by learning to trust your body again [PODCAST]

      The Podcast by KevinMD | Podcast
    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician
    • Unused IV catheters cost U.S. hospitals billions

      Piyush Pillarisetti | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 17 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • Healing from medical training by learning to trust your body again [PODCAST]

      The Podcast by KevinMD | Podcast
    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician
    • Unused IV catheters cost U.S. hospitals billions

      Piyush Pillarisetti | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Medicine leads the professions in suicide. What can we do about it?
17 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...